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Documents and Forms

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Newsletters

September 2013

September 2012

September 2011

September 2010

July 2009

June 2008

June 2007


Miscellaneous Forms

Enrollment/Beneficiary Designation Form

Change Of Address

Plan Documents

2013 Pension Plan 2nd Amendment

Plan A Summary Plan Document

Plan C Summary Plan Document

Plan H Summary Plan Document

Plan A Summary of Benefits and Coverage

Plan C Summary of Benefits and Coverage

Plan H Summary of Benefits and Coverage


Summary of Material Modifications

All Plan SMM - 5/2024

Plan A SMM - 8/2023

Plan C SMM - 8/2023

Pension Forms

Pension Application No Medical

W4 Withholding Federal Income Tax

Pension Direct Deposit

Request For Social Security Earnings

H&W Forms

1095B Form Request

HIPAA Privacy Statement

HIPAA Medical Authorization

Health & Welfare Information

Qualifying Life Event Notice

14 Front Street, Suite 301
Hempstead, NY 11550-3602
Phone 516-560-8500
Fax 516-486-7375